AB0212 COMPARISON OF THE EFFECTS OF POLYPHARMACY IN THE TREATMENT OF RHEUMATOID ARTHRITIS PATIENTS AND PSORIATIC ARTHRITIS PATIENTS WITH PERIPHERAL JOINT INVOLVEMENT
Authors: M. Kara, S. Palanbek Yavaş, A. Taşdemir, S. Ketenci
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are chronic, progressive inflammatory diseases that can be accompanied by other diseases. These patients use several medications, especially due to their comorbidities and widespread pain. In recent years, with the increase in the lifespan of individuals, the concept of polypharmacy has become more prominent. Accordingly, in our study, we aimed to present the prevalence of polypharmacy and its effects on these diseases. Objectives Demonstrating the prevalence of polypharmacy in RA and PsA, which are among the most frequently encountered inflammatory arthritides, and the effects of polypharmacy on disease activity. Methods This study included PsA patients with only peripheral joint involvement and no distal interphalangeal joint involvement and RA patients. The numbers of medications used by the patients at the onset of their treatment and in the sixth month of their treatment were recorded. Non-prescribed (over the counter), topical and herbal/homeopathic medications were excluded. Polypharmacy was accepted as the simultaneous use of at least five medications by the person. Disease activity score in 28 joints C-reactive protein (DAS-28 CRP) was used for disease activity for both diseases. In addition to these, the scores of the patients who attended their follow-ups in the 12th month were calculated and analyzed. The Charlson Comorbidity Index (CCI) scores of the patient were calculated based on their chronic diseases. Results The sample of the study included 232 RA and 73 PsA patients. Demographic and some clinical characteristics are shown in Table 1. The mean numbers of medication used by the patients at the onset of their treatment were respectively 5.09±2.89 and 4.03±2.7 for the RA and PsA patients, whereas these mean numbers were found consecutively as 8.67±3.58 and 7.71±3.3 in the sixth month of their treatment. Polypharmacy was present in the sixth month of the treatment in 217 (93.5%) RA and 61 (83.6%) PsA patients. Table 1. Demographic and some clinical features RA (n=232) PSA (n=73) Age (mean±SD) 55.2±13.66 48.4±13.43 Age Group &lt;65 years 171(73.7) 65(89) ≥65 years 61(26.3) 8(11) Sex Female, n (%) 172(74.1) 50(68.5) Male, n (%) 60(25.9) 23(31.5) Current smoker, n (%) 82(35.3) 33(45.2) The numbers of medication used 8.67±3.58 7.71±3.3 Polypharmacy at the Beginning of Treatment 115(49.6) 28(38.4) Polypharmacy in the sixth month of treatment 217(93.5) 61(83.6) CCI (n=232/72) (mean±SD) 1.25±0.88 1.31±0.71 0th month DAS-28 CRP (mean±SD) 4.91±1.28 4.68±1.03 6th month DAS-28 CRP (mean±SD) 3.14±1.06 2.86±0.99 12th month DAS-28 CRP (n=83/29) (mean±SD) 2.73±1.18 2.8±1.12 While the mean ages of the RA and PsA patients who had polypharmacy treatment at the beginning were respectively 59.21±12.65 and 53.5±13.81, their ages were significantly higher than the ages of those who did not receive polypharmacy treatment (respectively, 51.26±13.53 and 45.22±12.3). In RA ve PsA patients, the status of polypharmacy is higher in the groups in the groups aged 65 and over than those under 65 years of age, and it is statistically significant (p=0.001 and p=0.048, respectively). The risk of polypharmacy in people over 65 years of age in RA patients was 8.2 times, and the risk of polypharmacy in people over 65 years old in PSA patients was increased 6.3 times (p=0.015). In both the RA and PSA groups, patients with baseline polypharmacy had statistically significantly higher DAS-28 CRP scores at 6 months of treatment than those without baseline polypharmacy. (p&lt;0.001). While the higher DAS-28 CRP score was maintained at 12 months in the RA group with polypharmacy at baseline (p=0.006), this was not significant in the PSA group (p=0.07). Conclusion Polypharmacy was present both at the time of diagnosis and in the treatment process in the RA and PsA patients, and the presence of polypharmacy at the beginning of the treatment was among the factors that affected the treatment of these patients by significantly affecting their 6th-month DAS-28 CRP values. Disclosure of Interests None declared